Dr. De Oliveira is an Assistant Professor in the Department of Anesthesiology and at the Center for HealthCare Studies (CHS) -Institute for Public Health and Medicine at Northwestern University, Feinberg School of Medicine. CHS conducts cutting-edge research about the safety and quality of healthcare through interdisciplinary, multi-departmental collaborations of health services and outcomes researchers in order to inform and shape healthcare policy and to improve healthcare practices and the health of the nation. Dr. De Oliveira's long-term goal is to become an independent investigator in perioperative health services research and engage in research to improve patient centeredness of care, healthcare safety and quality for vulnerable perioperative patients. The number of surgeries performed in the ambulatory care setting in the US has increased by over 300 percent in the last decade with over 6 million ambulatory surgeries performed in seniors, annually. Dr. De Oliveira has demonstrated in a prior work that increased age is directly and independently associated with a 54% increase in unanticipated hospital admissions after ambulatory surgery (AS). In addition, Dr. De Oliveira provides preliminary evidence that seniors have poor adherence to post-surgical instructions and frequently commit medication errors when self-administering opioids after AS. Nonetheless, it is not known which specific risk factors make seniors more vulnerable to poor safety and quality outcomes after AS. Dr. De Oliveira hypothesizes that a patient-centered, multidimensional, transition of care intervention based on identified risk factors will improve post-discharge safety and quality for seniors after AS. In ordr to address the hypothesis, the project AIMs are to: 1) Determine the risk factors for poor post-discharge safety and quality outcomes in seniors after ambulatory surgery 2) Develop a patient-centered multidimensional transition of care intervention to improve safety and quality for seniors undergoing ambulatory surgery, and 3) Conduct a feasibility study of the ambulatory surgery transition of care intervention. With this award, Dr. De Oliveira intends to: (1) gain knowledge in health literacy research by designing perioperative health educational tools to low literacy patients, (2) acquire patient safety research skills by developing a new transition of car intervention for ambulatory surgical seniors , (3) obtain expertise in qualitative research methods by performing focus groups of seniors and other ambulatory surgery stakeholders to refine the transition of care intervention , and (4) develop proficiency in implementation science by implementing the novel intervention in a tertiary urban care hospital. This career development application directly aligns with two AHRQ's priority areas of focus: 1) improve health-care quality by accelerating implementation of patient-centered outcomes research and 2) make health-care safer. In addition, the project will study and engage seniors, a priority population for AHRQ.